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Click on boxes to expand/collapse detailed information.               Characterize symptoms                                                                     Medication history                                                           Past medical history                                                           Possible triggers                                                           Physical examination                                                           Labs and tests                                                           Imaging studies                                                           Diagnostic features                                                                                         Syncope                   Non syncope loss of consciousness                                                                     Known etiology Cardiovascular Orthostatic hypotension Reflex         Unknown etiology Determine if there are any high risk criteria:         Consider additional tests                                                                             High risk       low risk   Consider alternative diagnoses                                                                               Immediate in-hospital monitoring       Recurrent syncopes       Single syncope                                                                             If suspicion of structural hear disease: Order an echocardiography           Was it in high risk setting? Potential risk of physical injury Occupational implications                                                                                                                 Structural heart disease present Treat accordingly         No structural heart disease   Yes   No: No further evaluation                                                                                               Tilt testing

Characterize the symptoms

Drug	Adult dosage
Inhaled Short Acting β Agonists (SABA)
Albuterol/Bitolterol/Pirbuterol a) Nebulizer solution b) MDI	♦ 2.5-5 mg every 20 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as needed or 10-15 mg/hour continuously. ♦ 4-8 puffs every 20 mins upto 4 hours, then every 1-4 hours as needed.
Levalbuterol a) Nebulizer solution b) MDI	♦ 1.25-2.5 mg every 20 mins for 3 doses, then 1.25-5 mg every 1-4 hours as needed. ♦ 4-8 puffs every 20 mins upto 4 hours, then every 1-4 hours as needed.
Anticholinergics
Ipratropium bromide a) Nebulizer solution b) MDI	♦ 0.5 mg every 20 mins for 3 doses, then as needed. ♦ 8 puffs every 20 mins as needed for upto 3 hours.
Ipratropium with albuterol a) Nebulizer solution (each 3 ml containing 0.5 mg ipratropium and 2.5 mg albuterol) b) MDI (each puff contains 18 mcg ipratropium and 90 mcg albuterol)	♦ 3 ml every 20 mins for 3 doses, then as needed. ♦ 8 puffs every 20 mins as needed for 3 hours
Systemic corticosteroids
Prednisone/Prednisolone/Methylprednisolone	♦ 40-80 mg/day in 1 or 2 divided doses until peak expiratory flowrate (PEF) reaches 70% of personal best.

Clinical course	Unstable
Physical examination	Signs of heart failure
Functional class	IV
6MWD	Less than 400 m
Echocardiogram	RV Enlargement
Hemodynamics	RAP high CI low
BNP	Elevated/Increasing
Treatment	Intravenous prostacyclin and/or combination treatment
Frequency of evaluation	Q 1 to Q 3 months
FC assessment	Every clinic visit
6MWT	Every clinic visit
Echocardiogram2	Q 6 to Q 12 months/center dependent
BNP	center dependent
RHC	Q 6 to Q 12 months or clinical deterioration